Patients in North Carolina soon will have the right to choose their physical therapist (PT) under their health benefits plan and ensure that PT services will be covered. SB 656, sponsored by State Sen Jim Davis (R) and advocated for by the North Carolina Chapter, was signed by North Carolina Gov Beverly Perdue (D) on June 29 and goes into effect October 1. SB 656 specifies that whenever an insurance policy provides for certification of disability that is within the scope of practice of a licensed PT, the policyholder, insured, or beneficiary will have the right to choose the provider of the services.

According to Chapter President Dean McCall, PT, DPT, OCS, the chapter initiated the legislation after reports began surfacing that some patients were unnecessarily driving more than 90 miles and having to wait 3 to 4 weeks before being seen by other providers, when they could have been seen in their home town by their local physical therapist. In addition, SB 656 states that when any health benefit plan, subscriber contract, or policy of insurance issued by a health maintenance organization, hospital or medical service corporation, or insurer provides for coverage for, payment of, or reimbursement for physical therapist services, the insured or other persons entitled to benefits under the policy will be entitled to coverage or reimbursement for the services.

Comments

An issue I have encountered several times is that VA pt's have to drive excessively back and forth to get to the VA for PT benefits, when they could have been seen locally for same level of care. The VA informed us that if the pt lives w/in 50 mile radius of their facility that they will not cover OP PT by another provider. One particular pt had to drive 47 miles each way as a result. Does this new legislation change this?

Posted by Steve Duncan
on 7/13/2012 8:45 AM

I don't know about the law as it applies to the VA in NC, but in WI we have had some luck describing the travel as a hardship (our VA is 30 mi away) and been able to get certified to see VA pts here. Work with pt advocates in your area! I am proud of the NC legislation--hopefully more states are able to get that type of law enacted, especially for areas where rural clinics are so few and far between. Way to go NC!

Posted by Eliza Andrews
on 7/13/2012 4:25 PM

Excellent news for North Carolina. It's citizens are protected a little bit more from the for-profit business of insurance. By requiring beneficiaries to drive away from the nearest PT in order to get coverage, insurance companies were in effect depriving them of sufficient care, perhaps entirely. If I were a greedy insurance CEO, I would contract with a PT enough miles apart and with a small enough staff so that 80% of the beneficiaries would either have to drive >20 miles each way or be on a waiting list long enough to give up and get used to the pain a little. No claims = $$$$. For example, I get harassed all the time by TRICARE/Humana with denials and utilization management reviews. At the last one I got curious about the finances of the company: see HUM on the NYSE, their profit margin is well over $1 billion per year. Everything is a calculated effort on their part, and they are way ahead of legislators and the healthcare profession. I think I'm going to buy some stock in HUM now.

Posted by E Howard
on 7/13/2012 7:20 PM

Good for NC. Now, if the patient has the money, that patient can go to who ever they want. Big deal, what's new here? I don't think the law dictates who an insurance company wants to contract with. So the law has little impact. what we all should be working towards is ensuring that upcoming ACO's & new formed hospitals inform patients they have a choice. New Medicare policy under the ACA allows hoarding, turns a blind eye to anti-trust and self referral abuse.